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Independent Thallium-201 Accumulation and Fluorine-18-Fluorodeoxyglucose Metabolism in Glioma

Departments of Nuclear Medicine and Neurosurgery, Gunma University School of Medicine, Gunma
Department of Neurosurgery, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan

Correspondence: For reprints contact: Keigo Endo, MD, Department of Nuclear Medicine, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi, 371 Japan.

ABSTRACT

SPECT with ²⁰¹Tl is an effective procedure for evaluating the malignancy of glioma. Our goal was to investigate the diagnostic relevance of both ²⁰¹Tl SPECT and [¹⁸F]fluorodeoxyglucose (FDG) PET and the relation between ²⁰¹Tl uptake and glucose metabolism in glioma using comparative SPECT and PET studies. Methods: Thallium-201 SPECT and FDG dynamic PET studies were performed in 20 patients with untreated glioma (5 with glioblastoma, 5 with anaplastic glioma, 10 with low-grade glioma). Thallium-201 uptake in the tumor was estimated using the ²⁰¹Tl index, defined as the ratio of ²⁰¹Tl uptake in the tumor to that in the contralateral normal brain on SPECT images obtained 15 min after intravenous injection. We measured regional glucose metabolic parameters, including rate constants and regional cerebral metabolic rate of glucose utilization (rCMRgl), in the tumor. We then compared the regional ²⁰¹Tl index and glucose metabolic parameters with the histologic characteristics, malignancy and computed tomographic/magnetic resonance imaging findings. In addition, we investigated the correlation between the ²⁰¹Tl index and glucose metabolic parameters. Results: Thallium-201 SPECT showed abnormal ²⁰¹Tl uptake in all patients with glioblastoma and anaplastic glioma. Thallium-201 indices of glioblastoma (202.6 ± 22.1%) and anaplastic glioma (176.6% ± 26.6%) were significantly higher than that for low-grade glioma (106.7% ± 13.8%). The rCMRgl value of glioblastoma (17.6 ± 3.5 /µmole/100g/min) was also significantly higher than that for low-grade glioma (10.8 ± 4.5 µmole/100 g/min), although rCMRgl showed a large variability in both high- and low-grade glioma. Rate constants of FDG kinetics had no correlation with histological grade of glioma. Some patients with high-grade glioma, however, showed false-negative results with FDG-PET because of high normal brain uptake of FDG. Conversely, most low-grade glioma could not be localized by ²⁰¹Tl SPECT. There was no correlation between the ²⁰¹Tl index and glucose metabolic parameters. Conclusion: Thallium-201 indices and rCMRgl values for glioblastoma were higher than those for low-grade glioma. Thallium-201 uptake in the tumor may be independent of increased glucose transport or metabolism. Thallium-201 SPECT and FDG-PET are complementary in the diagnosis of glioma, although ²⁰¹Tl SPECT is more significantly correlated with the malignancy of glioma.

Key Words: thallium-201 • SPECT • fluorine-18-fluorodeoxyglucose • PET • glioma

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